Elbow dislocation with ipsilateral open radial and ulnar diaphyseal fractures — a rare combination

An 8-year-old Caucasian male was referred to our unit with a left upper limb injury sustained during a fall from a playground slide. The exact mechanism of injury is unknown but it was reported that the patient’s full body weight was transmitted through the left arm on impact. Examination revealed a markedly swollen left elbow and left forearm deformity with two 1 cm lacerations on the volar aspect of the forearm approximately 4 cm from the wrist joint. Neurovascular examination was normal and there were no other injuries noted. Radiographic examination revealed a posterior dislocation of the left elbow associated with grossly displaced distal third fractures of the radius and ulna (Fig. 1). Elbow reduction and wound toilet were performed under sedation in the emergency room. A stable arc of motion was elicited at the elbow post reduction. Intravenous antibiotics (cefotaxime 750 mg) and tetanus toxoid were administered. The patient was transferred to the operating room and a thorough wound debridement was performed through a z-shaped volar incision incorporating the lacerations.Both lacerationscommunicatedwith the respective fracture sites. Severe soft tissue damage was noted with considerable local damage to the bellies of the flexor muscles. The radial fracture was reduced and stabilized with two crossed 1.6 mm Kirschner wires. The ulna was approached through a separate ulnar incision, reduced and stabilized with a single cross 1.6 mm Kirschner wire. Postoperative films demonstrated satisfactory reduction and alignment of the radius and ulna (Fig. 2). On the morning of the first postoperative day the patient was found to have symptoms and signs suggestive of a flexor compartment syndrome. The volar compartments were immediately decompressed with a complete volar fasciotomy. All flexor muscles, both superficial and deep, were viable. The wound was inspected 48 h later and partial skin closure obtained. Complete wound closure was not subsequently obtained due to residual swelling and a split thickness skin graft was performed. The patient made an uneventful postoperative recovery. The skin graft took fully. A long arm cast was employed until the Kirschner wires were removed at 6 weeks. Both fractures went on to solid union (Fig. 3). Left elbow and wrist range of motion returned to normal over the following 6 months.